ACCEPTANCE AND DELIVERY RECORD

IAI SUPPLIER CODE: PAGE OF

COVER - CONTENTS
A/C TYPE & SERIAL No. OPPS ASSEMBLY No. OPPS ASSEMBLY NAME P. O. No.

QTY. OF PAGES
CONTENTS
PAGES

A - FATIGUE AND FRACTURE CRITICAL PARTS (AS APPLICABLE)

B - LOOSE PARTS WITH THE SHIPMENT (AS APPLICABLE)

C - OPEN OPERATIONS/WORK TO BE ACCOMPLISHED/ITEMS SHORT (ITL) (COMPULSORY)

D - TEST RESULTS (AS APPLICABLE)

E - LIST OF NONCONFORMANCES (AS APPLICABLE)

F - SERIALIZED ITEMS INSTALLED (AS APPLICABLE)

G - SUPPLIER CERTIFICATE OF CONFORMITY (COMPULSORY)

H – DECLARATION OF CONFIGURATION (COMPULSORY)

IF INFORMATION REQUIRED FOR COMMUNICATION OF DATA LISTED UNDER CONTENTS ABOVE IS MINIMAL AND
ADDITIONAL DATA FORMS ARE NOT REQUIRED, REFERENCE MAY BE MADE TO THE CONTENT CATEGORY AND SPECIFIC
DATA ENTERED IN THE REMARKS BLOCK BELOW.

REMARKS:

SUPPLIER QUALITY ASSURANCE:

THE ABOVE IDENTIFIED COMPONENT HAS
Name:
Signature: BEEN RECEIVED IN PROPER CONDITION

I.A.I. QUALITY ASSURANCE: Name:

DATE OF DELIVERY:
Name:
Signature:
Signature:

400-3-1423
Rev.: 10/2012